Delivering High-Quality Cancer Care Charting a New Course for a System in Crisis (2013) / Chapter Skim
Currently Skimming:
1 Introduction
1 Introduction
Pages 19-42
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From page 19... ...
Most often this occurs because the clinician lacks knowledge of how to provide this care (or how to make referrals to palliative care consultants) or does not identify palliative care management as an important component of high-quality cancer care.
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. In addition, the costs of cancer treatments are escalating unsustainably, making cancer care less affordable for patients and their families, and creating disparities in patients' access to high-quality cancer care
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. In addition, the Cancer Quality Alliance, a diverse group of stakeholders committed to advocating for improvements in the quality of cancer care, used the 1999 IOM report and several other reports to develop five cancer case studies depicting a vision for high-quality cancer care and a blueprint for action (Rose et al., 2008)
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Recommendation 2: Use systematically developed guidelines based on the best available evidence for prevention, diagnosis, treatment, and palliative care. Progress to date • he National Comprehensive Cancer Care Network, the American So T ciety of Clinical Oncology, and the American Society of Radiation On cology have worked with clinical experts to develop guidelines for more than 135 cancers or processes of care.
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• ost cancer centers in the United States have inpatient palliative care M consult teams. Current gaps • atients with advanced cancer frequently receive palliative care late in P their disease course, which compromises quality of life and quality of care for them and their families.
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Progress to date • his recommendation has not been implemented because of the current T nature of clinical trials. Current gaps • ancer care management is addressed in Recommendation 8.
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Progress to date • rograms have been introduced to increase the involvement of can P cer centers designated by the National Cancer Institute in developing research, education, and outreach programs to reduce cancer health disparities. Current gaps • here are ongoing disparities, including later stage diagnoses and T poorer outcomes for racial and ethnic minorities with cancer.
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. Committee Charge The charge to the committee was to revisit the quality of cancer care more than a decade after publication of the first IOM report, Ensuring Quality Cancer Care (1999)
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The committee will • eview various aspects of quality cancer care, including the coordination R and organization of care, outcomes reporting, quality metrics, and dispari ties in care; • onsider the growing need for survivorship care, palliative care, and infor C mal caregiving; • onsider the increasing complexity and cost of cancer care, for example C through incorporation of biomarkers to predict response to therapy; • onsider potential opportunities to improve the quality of care by aligning C incentives to promote more effective models of care delivery or through specific payment reforms; and • onsider how patients can identify, find, and access high-quality cancer C care. Scope of the Report This report presents a conceptual framework for improving the quality of cancer care.
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From page 28... ...
The acute phase of cancer care occurs immediately after a person is diagnosed with cancer, and generally includes surgical interventions and initial chemotherapy and radiation therapies, as well as palliative and psychosocial care as needed by the patient. Although acute care is often associated with hospitalization for complex conditions, newly diagnosed cancer patients will generally have minimal contact with the inpatient hospital setting.
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From page 29... ...
The green arrow identifies three overlapping phases of cancer care, which are a way of conceptualizing the period of the cancer care continuum that is the focus of this report. SOURCE: Adapted from National Cancer Institute figure on the "Cancer Control Continuum" (NCI, 2013b)
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. The current health care delivery system is poorly prepared to address 53% of cancer diagnoses were in individuals ≥65 years old in 2012 Total people diagnosed with cancer: 1.6 million Cancer diagnoses ≥65 years old: 868,000 FIGURE 1-2 The majority of cancer diagnoses are in older adults.
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NOTE: The committee adopted the National Coalition for Cancer Survivorship's definition of a cancer survivor, which states that a survivor is any person who has been diagnosed with cancer, from the time of diagnosis through the balance of life (IOM and NRC, 2005)
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Since the 1999 report was released, the IOM has produced a number of foundational consensus studies addressing particular aspects of high-quality cancer care (e.g., Interpreting the Volume-Outcome Relationship in the Context of Cancer Care [IOM, 2001] ; From Cancer Patient to Cancer Survivor: Lost in Transition [IOM and NRC, 2005]
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. Structural quality refers to the ability of a health care system to meet the needs of patients or communities; process quality refers to the technical skills of health care clinicians and their interactions with patients; and outcomes quality refers to changes in patients' health status (e.g., morbidity and mortality)
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The committee identified six components of a high-quality cancer care delivery system that will be integral to this transformation:
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. Figure 1-5 illustrates the interconnectivity of the committee's six components for a high-quality cancer care delivery system.
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The committee numbered its six components for high-quality cancer care in order of priority for implementation, taking into account both the need and the feasibility of achieving each component of the framework. Thus, achieving a system that supports patient decision making is the top priority, followed by an adequately staffed, trained, and coordinated workforce, evidence-based cancer care, a learning health care IT system, the translation of evidence into practice, measurement of outcomes, and performance improvement, and, finally, accessible and affordable cancer care.
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It also targets the federal government, where appropriate, because the government is in a position to develop national strategies and to influence the policies that affect the behavior of those involved in the provision of cancer care. In addition, as the dominant health insurance provider for cancer patients and survivors, the federal government has a responsibility to assure that its payments for services meet quality standards and are not harmful to patients.
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Chapters 3 through 8 elaborate on the committee's six components for a high-quality cancer care system and present the committee's recommendations for action. Chapter 2: The Current Cancer Care Landscape: An Imperative for Change, focuses on demographic changes in the United States; trends in cancer diagnoses, cancer survivorship, cancer treatment, and cancer care costs; the unique needs of older adults with cancer; and policy initiatives that may impact cancer care.
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Chapter 7: Translating Evidence into Practice, Measuring Quality, and Improving Performance, focuses on translating evidence into practice through quality metrics, clinical practice guidelines, and performance improvement initiatives. Chapter 8: Accessible and Affordable Cancer Care, focuses on access to cancer care and on the role of payers, clinicians, and patients in improving affordability and quality of cancer care.
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2009b. Ensuring quality cancer care through the oncology workforce: Sustaining care in the 21st century: Workshop summary.
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2009. Achiev ing world class: An independent review of the design plans for the Walter Reed National Military Medical Center and the Fort Belvoir Community Hospital.
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2013. Identify ing survival associated morphological features of triple negative breast cancer using multiple datasets.
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